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Master's Dissertation
DOI
https://doi.org/10.11606/D.58.2019.tde-21032019-171333
Document
Author
Full name
Maysa Nogueira de Barros Melo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2018
Supervisor
Committee
Trivellato, Alexandre Elias (President)
Romano, Fábio Lourenço
Sverzut, Alexander Tadeu
Vieira, Eduardo Hochuli
 
Title in Portuguese
Estudo laboratorial da acurácia do planejamento virtual 3D em cirurgia ortognática
Keywords in Portuguese
Acurácia
Cirurgia ortognática
Planejamento virtual
Abstract in Portuguese
Os guias cirúrgicos são importantes neste caso, pois transferirão a informação do planejamento cirúrgico para o ato cirúrgico e permitirão a realização cirúrgica do movimento e as novas posições planejadas de maxila e / ou mandíbula, para corrigir a deformidade dentofacial do paciente. Assim, a preparação de guias cirúrgicos assume grande importância no sucesso do tratamento, sendo o foco deste trabalho. Foram selecionados oito pacientes previamente submetidos à cirurgia ortognática e cada paciente deu origem a um grupo, de acordo com o movimento maxilar. Grupo 1 (avanço), Grupo 2 (reposicionamento superior do incisivo - RSI), Grupo 3 (reposicionamento superior dos molares - RSM), Grupo 4 (mudança da linha média), Grupo 5 (reposicionamento inferior de incisivos - RII) Grupo 6 (reposicionamento inferior de molares - RIM), Grupo 7 (avanço com RSI e RIM) e Grupo 8 (avanço com RII e RSM) de acordo com a deformidade dentofacial do paciente. Para os Grupos de 1 a 6 planejou-se duas amplitudes de movimentação (3 e 6mm) e para os Grupos 7 e 8 apenas uma amplitude (6mm). O software de planejamento virtual Dolphin Imaging 11.9® importou imagem de exame tomografia computadorizada e digitalização de arcos dentários. Foram realizadas simulações de cirurgia virtual em 3D e guias cirúrgicos virtuais foram obtidos e exportados para impressora 3D (impressão em resina). Em articulador semi-ajustável (ASA), o modelo da maxila foi separado da plataforma de montagem e o guia cirúrgico obtido do planejamento virtual 3D foi utilizado para remontar o modelo da maxila ligado ao modelo da mandíbula (posicionado de acordo com arco facial e registro pré-operatório). A maxila foi fixada na nova posição e transferida para a mesa de Erickson, na qual as medidas foram feitas para verificar o movimento planejado (direção e quantidade de movimento). Os dados foram tabulados e submetidos à análise estatística para avaliação da concordância entre o planejamento virtual 3D e os valores encontrados na Mesa de Erickson. Observou-se excelente concordância entre os métodos, independentemente da direção, ponto de referência analisado ou quantidade da movimentação (3 ou 6mm). A maior variação encontrada foi de 0,42mm na amplitude de movimentação de 6mm e a maior média (0,07mm) na região do elemento 16, evidenciando a alta concordância entre os métodos de obtenção de guias cirúrgicos para cirurgia ortognática. Não foram encontradas diferenças estatisticamente significantes, e portanto, a obtenção de guias cirúrgicos por meio do planejamento virtual 3D em cirurgia ortognática possui excelente concordância com a tradicional Mesa de Erickson (Cirurgia de Modelos)
 
Title in English
Comparative study between 3D virtual planning and Erickson table in orthognathic surgery
Keywords in English
Accuracy
Orthognathic surgery
Virtual planning
Abstract in English
Surgical guides are important in this case, since they will transfer the information of surgical planning to the surgical act and allow the surgical achievement of the movement and the new planned positions of maxilla and / or mandible, to correct the patient´s dentofacial deformity. Thus, preparation of surgical guides assumes great importance on treatment success, being the focus of this work. It was selected eight patients previously submitted to Orthognathic Surgery and each patient gave rise to a group, according to the maxillary movement. Group 1 (advancement), Group 2 (upper repositioning of incisor - URI), Group 3 (upper repositioning of molars - URM), Group 4 (midline changing), Group 5 (down repositioning of incisors DRI) Group 6 (down repositioning of molars - DRM), Group 7 (advancement with URI and DRM) and Group 8 (advancement with DRI and URM) according to the patient´s dentofacial deformity. To Groups 1 to 6 two amplitudes of movement were planned (3 and 6mm) and for Groups 7 and 8 only one amplitude (6mm). Dolphin Imaging 11.9® virtual planning software imported image of computed tomographic examination and scanning of dental arches. Simulation of 3D virtual surgery was performed and virtual surgical guides obtained, which were exported to the 3D printer (resin impression). In semi-adjustable articulator (SAA) the maxilla model was separated from the SAA mounting platform and the surgical guide obtained from 3D virtual surgical planning was used to reassemble the maxilla model linked to mandible model (positioned according to facial bow and preoperative registration). The maxilla was fixed in the new position and transferred to Erickson's table, in which measurements were made to verify the planned movement (direction and amount of movement). The data were tabulated and submitted to statistical analysis to evaluate the agreement between 3D virtual planning and the values found in Erickson's Table. There was an excellent agreement between the methods, regardless of direction, reference point analyzed or amount of movement (3 or 6mm). The greatest variation was 0.42 mm in the movement amplitude of 6mm and the highest mean (0,07mm) in the region of element 16, evidencing the high agreement between the methods of attainment of surgical guides for orthognathic surgery. No statistical significant differences were found, and so, the attainment of surgical guides for orthognathic surgery by 3D virtual surgical planning in orthognathic surgery has an excellent agreement with the traditional Erickson´s table (Model Surgery)
 
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Publishing Date
2019-07-17
 
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